Abstract 27: Opioid Use Strongly Increases Incidence of Acute Kidney Injury in Patients With Acute Ischemic Stroke: An Analysis of 3.4 Million Admissions

Abstract

Background: The relationship of opioid use with the incidence of acute ischemic stroke (AIS) and subsequent complications remains poorly understood. However, both opioid use and AIS have been independently associated with increased risk of subsequent acute kidney injury (AKI). In patients with AIS patients, AKI is associated with increased in-hospital and 10-year mortality. We evaluate whether opioid use in patients with AIS is associated with increased risk of AKI, near-term complications, mortality, and increased healthcare utilization. Methods: All records of patients within the Nationwide Inpatient Sample carrying a primary discharge diagnosis of AIS and secondary diagnosis of AKI between 2012-2014 were stratified by opioid status. The effect of opioid use on outcomes following AIS was analyzed after adjusting for confounders using logistic regression analysis. Results: Of 3,396,664 patients with AIS, 17,575 were diagnosed with an opioid-use disorder. There were 4,786 (27.2%) patients with AIS with opioid use that experienced in-hospital AKI compared to 426,823 (12.6%, p<0.01) patients without opioid use, despite patients with opioid use being younger (53 vs. 70 years, p<0.01) with fewer comorbidities, including CHD, CKD, hypertension, and diabetes. Patients with opioid use had longer hospitalizations (10 vs. 6.5 days; p < 0.01) and higher costs ($26,022 vs. $16,419, p < 0.01). Adjusting for confounding factors, opioid use among AIS patients was associated with an increased odds of AKI (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.8-2.2; p<0.01), major bleed (OR=1.2; 95% CI=1.0-1.3; p=0.04), and in-hospital mortality (OR=1.3; 95% CI=1.1-1.5; p<0.01). Conclusions: We demonstrate that opioid use in patients with acute ischemic stroke is independently associated with twofold increased risk of AKI (27% vs. 12%, p<0.01; [OR]=2.0; 95% CI=1.8-2.2; p<0.01). As AKI is strongly associated with increased in-hospital and long-term mortality in patients with stroke, opioid use carries particularly significant implications for prognosis and management of the AIS population. Strategic measures designed to reduce incidence of AKI in AIS patients with opioid use may reduce complications, healthcare utilization, and mortality following stroke.